NR 509 Advanced Physical Assessment
Midterm & Final Exams (2025/2026) |
Actual Exams | Comprehensive Health
Assessment Package
1. A 55-year-old man reports sudden onset chest pain radiating to the left arm and
jaw. Which physical-exam sign most strongly suggests myocardial ischemia?
A. Loud S1
B. New S4 heart sound
C. Pericardial friction rub
D. Peripheral edema
Answer: B. New S4 heart sound. Rationale: S4 indicates decreased ventricular
compliance, often with ischemia or LV hypertrophy.
2. While auscultating lungs, you hear high-pitched inspiratory wheezes localized to
one lobe. This most likely indicates:
A. Pulmonary edema
B. Bronchiectasis
C. Partial airway obstruction (localized)
D. Pleural effusion
Answer: C. Partial airway obstruction (localized). Rationale: Focal wheeze
suggests localized airway narrowing.
3. On abdominal exam, a bruit in the epigastrium that radiates to the back suggests:
A. Hepatic cirrhosis
B. Renal artery stenosis or abdominal aortic aneurysm
C. Bowel obstruction
D. Peptic ulcer disease
Answer: B. Renal artery stenosis or abdominal aortic aneurysm. Rationale:
Vascular bruits in epigastrium suggest arterial turbulence.
4. A brisk, symmetric pupillary constriction to light with intact accommodation but
no response to direct light indicates lesion at:
A. Optic nerve
B. Oculomotor nerve or efferent pathway
C. Parasympathetic nucleus of Edinger-Westphal
D. Afferent pathway of retina
, Answer: B. Oculomotor nerve or efferent pathway. Rationale: Absent efferent
pupillary response with intact afferent function points to efferent defect.
5. A patient has a systolic crescendo-decrescendo murmur best heard at right upper
sternal border that radiates to the carotids. Most likely diagnosis:
A. Mitral regurgitation
B. Aortic stenosis
C. Hypertrophic cardiomyopathy
D. Atrial septal defect
Answer: B. Aortic stenosis. Rationale: Classic location and carotid radiation for
AS.
6. Deep tendon reflexes are 3+ bilaterally. This suggests:
A. Upper motor neuron lesion or hyperreflexia
B. Lower motor neuron lesion
C. Normal finding in all adults
D. Peripheral neuropathy
Answer: A. Upper motor neuron lesion or hyperreflexia. Rationale: 3+ suggests
brisk/hyperactive reflexes.
7. Clubbing of the nails is most commonly associated with:
A. Iron deficiency anemia
B. Chronic hypoxia such as bronchiectasis or lung cancer
C. Acute bronchitis
D. Dermatitis
Answer: B. Chronic hypoxia such as bronchiectasis or lung cancer. Rationale:
Clubbing occurs with chronic hypoxic or inflammatory lung disease.
8. A late inspiratory crackle heard at the lung bases that does not clear with
coughing is most consistent with:
A. COPD
B. Pulmonary fibrosis or interstitial disease
C. Asthma
D. Upper airway secretions
Answer: B. Pulmonary fibrosis or interstitial disease. Rationale: Fine late
inspiratory crackles reflect alveolar interstitial involvement.
9. Which of the following describes a positive Murphy’s sign?
A. RUQ pain with deep inspiration and palpation under costal margin
B. LUQ rebound tenderness
C. Psoas sign with hip extension
D. Pain on percussion over CVA
Answer: A. RUQ pain with deep inspiration and palpation under costal margin.
, Rationale: Murphy’s indicates gallbladder inflammation.
10.When assessing gait, a patient with a wide-based, staggering gait and intention
tremor most likely has dysfunction in:
A. Basal ganglia
B. Cerebellum
C. Vestibular apparatus only
D. Peripheral nerves
Answer: B. Cerebellum. Rationale: Cerebellar disease gives ataxic, wide-based
gait and intention tremor.
11.A 30-year-old woman has exophthalmos, heat intolerance, and a fine tremor. On
exam you expect:
A. Dry skin and bradycardia
B. Diffuse goiter and tachycardia
C. Decreased deep tendon reflexes
D. Myxedema
Answer: B. Diffuse goiter and tachycardia. Rationale: Hyperthyroidism causes
tachycardia, goiter, tremor, heat intolerance.
12.On auscultation you hear a holosystolic murmur loudest at apex radiating to axilla
— diagnosis:
A. Aortic regurgitation
B. Mitral regurgitation
C. Tricuspid stenosis
D. VSD
Answer: B. Mitral regurgitation. Rationale: Holosystolic MR radiates to axilla.
13.Which percussion finding suggests consolidation (lobar pneumonia) rather than
pleural effusion?
A. Dullness with decreased fremitus
B. Hyperresonance with decreased fremitus
C. Dullness with increased fremitus
D. Tympany with increased fremitus
Answer: C. Dullness with increased fremitus. Rationale: Consolidation transmits
vibration, increasing fremitus.
14.The most appropriate technique to assess for ascites on physical exam is:
A. CVA tenderness
B. Murphy’s punch
C. Shifting dullness and fluid wave
D. McBurney’s point palpation
Answer: C. Shifting dullness and fluid wave. Rationale: These detect free
, peritoneal fluid.
15.A child with inspiratory stridor that improves when prone and has barking cough
likely has:
A. Epiglottitis
B. Croup (laryngotracheobronchitis)
C. Foreign body aspiration
D. Bronchiolitis
Answer: B. Croup (laryngotracheobronchitis). Rationale: Barking cough and
stridor are typical for viral croup.
16.A bruit heard in the neck over the carotid artery suggests:
A. Aortic stenosis
B. Carotid artery stenosis
C. Jugular venous reflux
D. Tracheal obstruction
Answer: B. Carotid artery stenosis. Rationale: Bruit indicates turbulent flow from
stenosis.
17.The presence of a pericardial friction rub is most indicative of:
A. Mitral valve prolapse
B. Pericarditis
C. Heart failure
D. Aortic dissection
Answer: B. Pericarditis. Rationale: Friction rub = pericardial inflammation.
18.A difference of >10 mm Hg in systolic BP between arms suggests:
A. Normal variant
B. Subclavian stenosis or aortic dissection
C. Dehydration
D. Peripheral neuropathy
Answer: B. Subclavian stenosis or aortic dissection. Rationale: Significant
inter-arm difference suggests vascular pathology.
19.For assessing tactile fremitus, what is the best instruction for the patient?
A. Say “eee” repeatedly
B. Hum a low note
C. Say “ninety-nine” or “one-one-one”
D. Take deep breaths in and out
Answer: C. Say “ninety-nine” or “one-one-one”. Rationale: These voiced sounds
transmit vibrations for fremitus.
20.A 70-year-old with decreased breath sounds, dullness to percussion, and tracheal
deviation away from lesion likely has:
Midterm & Final Exams (2025/2026) |
Actual Exams | Comprehensive Health
Assessment Package
1. A 55-year-old man reports sudden onset chest pain radiating to the left arm and
jaw. Which physical-exam sign most strongly suggests myocardial ischemia?
A. Loud S1
B. New S4 heart sound
C. Pericardial friction rub
D. Peripheral edema
Answer: B. New S4 heart sound. Rationale: S4 indicates decreased ventricular
compliance, often with ischemia or LV hypertrophy.
2. While auscultating lungs, you hear high-pitched inspiratory wheezes localized to
one lobe. This most likely indicates:
A. Pulmonary edema
B. Bronchiectasis
C. Partial airway obstruction (localized)
D. Pleural effusion
Answer: C. Partial airway obstruction (localized). Rationale: Focal wheeze
suggests localized airway narrowing.
3. On abdominal exam, a bruit in the epigastrium that radiates to the back suggests:
A. Hepatic cirrhosis
B. Renal artery stenosis or abdominal aortic aneurysm
C. Bowel obstruction
D. Peptic ulcer disease
Answer: B. Renal artery stenosis or abdominal aortic aneurysm. Rationale:
Vascular bruits in epigastrium suggest arterial turbulence.
4. A brisk, symmetric pupillary constriction to light with intact accommodation but
no response to direct light indicates lesion at:
A. Optic nerve
B. Oculomotor nerve or efferent pathway
C. Parasympathetic nucleus of Edinger-Westphal
D. Afferent pathway of retina
, Answer: B. Oculomotor nerve or efferent pathway. Rationale: Absent efferent
pupillary response with intact afferent function points to efferent defect.
5. A patient has a systolic crescendo-decrescendo murmur best heard at right upper
sternal border that radiates to the carotids. Most likely diagnosis:
A. Mitral regurgitation
B. Aortic stenosis
C. Hypertrophic cardiomyopathy
D. Atrial septal defect
Answer: B. Aortic stenosis. Rationale: Classic location and carotid radiation for
AS.
6. Deep tendon reflexes are 3+ bilaterally. This suggests:
A. Upper motor neuron lesion or hyperreflexia
B. Lower motor neuron lesion
C. Normal finding in all adults
D. Peripheral neuropathy
Answer: A. Upper motor neuron lesion or hyperreflexia. Rationale: 3+ suggests
brisk/hyperactive reflexes.
7. Clubbing of the nails is most commonly associated with:
A. Iron deficiency anemia
B. Chronic hypoxia such as bronchiectasis or lung cancer
C. Acute bronchitis
D. Dermatitis
Answer: B. Chronic hypoxia such as bronchiectasis or lung cancer. Rationale:
Clubbing occurs with chronic hypoxic or inflammatory lung disease.
8. A late inspiratory crackle heard at the lung bases that does not clear with
coughing is most consistent with:
A. COPD
B. Pulmonary fibrosis or interstitial disease
C. Asthma
D. Upper airway secretions
Answer: B. Pulmonary fibrosis or interstitial disease. Rationale: Fine late
inspiratory crackles reflect alveolar interstitial involvement.
9. Which of the following describes a positive Murphy’s sign?
A. RUQ pain with deep inspiration and palpation under costal margin
B. LUQ rebound tenderness
C. Psoas sign with hip extension
D. Pain on percussion over CVA
Answer: A. RUQ pain with deep inspiration and palpation under costal margin.
, Rationale: Murphy’s indicates gallbladder inflammation.
10.When assessing gait, a patient with a wide-based, staggering gait and intention
tremor most likely has dysfunction in:
A. Basal ganglia
B. Cerebellum
C. Vestibular apparatus only
D. Peripheral nerves
Answer: B. Cerebellum. Rationale: Cerebellar disease gives ataxic, wide-based
gait and intention tremor.
11.A 30-year-old woman has exophthalmos, heat intolerance, and a fine tremor. On
exam you expect:
A. Dry skin and bradycardia
B. Diffuse goiter and tachycardia
C. Decreased deep tendon reflexes
D. Myxedema
Answer: B. Diffuse goiter and tachycardia. Rationale: Hyperthyroidism causes
tachycardia, goiter, tremor, heat intolerance.
12.On auscultation you hear a holosystolic murmur loudest at apex radiating to axilla
— diagnosis:
A. Aortic regurgitation
B. Mitral regurgitation
C. Tricuspid stenosis
D. VSD
Answer: B. Mitral regurgitation. Rationale: Holosystolic MR radiates to axilla.
13.Which percussion finding suggests consolidation (lobar pneumonia) rather than
pleural effusion?
A. Dullness with decreased fremitus
B. Hyperresonance with decreased fremitus
C. Dullness with increased fremitus
D. Tympany with increased fremitus
Answer: C. Dullness with increased fremitus. Rationale: Consolidation transmits
vibration, increasing fremitus.
14.The most appropriate technique to assess for ascites on physical exam is:
A. CVA tenderness
B. Murphy’s punch
C. Shifting dullness and fluid wave
D. McBurney’s point palpation
Answer: C. Shifting dullness and fluid wave. Rationale: These detect free
, peritoneal fluid.
15.A child with inspiratory stridor that improves when prone and has barking cough
likely has:
A. Epiglottitis
B. Croup (laryngotracheobronchitis)
C. Foreign body aspiration
D. Bronchiolitis
Answer: B. Croup (laryngotracheobronchitis). Rationale: Barking cough and
stridor are typical for viral croup.
16.A bruit heard in the neck over the carotid artery suggests:
A. Aortic stenosis
B. Carotid artery stenosis
C. Jugular venous reflux
D. Tracheal obstruction
Answer: B. Carotid artery stenosis. Rationale: Bruit indicates turbulent flow from
stenosis.
17.The presence of a pericardial friction rub is most indicative of:
A. Mitral valve prolapse
B. Pericarditis
C. Heart failure
D. Aortic dissection
Answer: B. Pericarditis. Rationale: Friction rub = pericardial inflammation.
18.A difference of >10 mm Hg in systolic BP between arms suggests:
A. Normal variant
B. Subclavian stenosis or aortic dissection
C. Dehydration
D. Peripheral neuropathy
Answer: B. Subclavian stenosis or aortic dissection. Rationale: Significant
inter-arm difference suggests vascular pathology.
19.For assessing tactile fremitus, what is the best instruction for the patient?
A. Say “eee” repeatedly
B. Hum a low note
C. Say “ninety-nine” or “one-one-one”
D. Take deep breaths in and out
Answer: C. Say “ninety-nine” or “one-one-one”. Rationale: These voiced sounds
transmit vibrations for fremitus.
20.A 70-year-old with decreased breath sounds, dullness to percussion, and tracheal
deviation away from lesion likely has:
